title: Similar decreases in local tumor control are calculated for treatment protraction and for interruptions in the radiotherapy of carcinoma of the larynx in four centers.
abstract: OBJECTIVE
  Data on patients with cancer of the larynx are analyzed using statistical models to estimate the effect of gaps in the treatment time on the local control of the tumor.
  
  
  METHODS
  Patients from four centers, Edinburgh, Glasgow, Manchester, and Toronto, with carcinoma of the larynx and treated by radiotherapy were followed up and the disease-free period recorded. In all centers the end point was control of the primary tumor after irradiation alone. The local control rates at > or = 2 years, Pc, were analyzed by log linear models, and Cox proportional hazard models were used to model the disease-free period.
  
  
  RESULTS
  T stage, nodal involvement, and site of the tumor were important determinants of the disease-free interval, as was the radiation schedule used. Elongation of the treatment time by 1 day, or a gap of 1 day, was associated with a decrease in Pc of 0.68% per day for Pc = 0.80, with a 95% confidence interval of (0.28, 1.08)%. An increase of 5 days was associated with a 3.5% reduction in Pc from 0.80 to 0.77. At Pc = 0.60 an increase of 5 days was associated with an 7.9% decrease in Pc. The time factor in the Linear Quadratic model, gamma/alpha, was estimated as 0.89 Gy/day, 95% confidence interval (0.35, 1.43) Gy/day.
  
  
  CONCLUSIONS
  Any gaps (public holidays are the majority) in the treatment schedule have the same deleterious effect on the disease free period as an increase in the prescribed treatment time. For a schedule, where dose and fraction number are specified, any gap in treatment is potentially damaging.
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Robertson
authors.forename: A G
authors.initials: AG
authors.lastname: Robertson
authors.forename: J H
authors.initials: JH
authors.lastname: Hendry
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: N J
authors.initials: NJ
authors.lastname: Slevin
authors.forename: W B
authors.initials: WB
authors.lastname: Duncan
authors.forename: R H
authors.initials: RH
authors.lastname: MacDougall
authors.forename: G R
authors.initials: GR
authors.lastname: Kerr
authors.forename: B
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: T J
authors.initials: TJ
authors.lastname: Keane
mesh_terms: D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016019:Survival Analysis; D013997:Time Factors